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SANZ et al .
Applicability Anatomical considerations related to the width of the interdental space advise on the choice of the preferred flap design to access the interdental area (Cortellini, Prato, & Tonetti, 1995, 1999). Location and configuration of the intrabony defect advise on the possibility to (a) minimize flap extension (Cortellini & Tonetti, 2007; Harrel, 1999), and (b) raise a single flap or the need to fully elevate the interdental papilla (Cortellini & Tonetti, 2009; Trombelli, Farina, Franceschetti, & Calura, 2009).
Consistency Following treatment, moderate to substantial heterogeneity in the size of the effect (wide ranges of tooth survival) was observed. The reasons cannot be determined from the existing data. Clinical relevance and effect size Following treatment, reasonable survival rates were observed over 4–30.8 years. Overall, the observed tooth survival rates were better in Class II furcation involvement than Class III.
Balance of benefit and harm We did not identify data about harm directly related to procedures.
7.6 | Intervention: Management of furcation lesions
R3.10 | What is the adequate management of molars with Class II and III furcation involvement and residual pockets? Evidence-based recommendation and statement (3.10) A We recommend that molars with Class II and III furcation involvement and residual pockets receive periodontal therapy. B Furcation involvement is no reason for extraction. Supporting literature Dommisch et al. (2020); Jepsen et al. (2019) Quality of evidence Regenerative treatment: 20 RCTs (575 patients) Resective treatment: Seven observational studies (665 patients) with low quality of evidence Grade of recommendation A. Grade A—↑↑ B. Statement A. Strength of consensus Strong consensus (1.5% of the group abstained due to potential CoI) B. Strength of consensus Consensus (1.5% of the group abstained due to potential CoI)
Economic considerations Simulations based on the German health system have indicated that tooth retention after complex periodontal therapy of teeth with furcation involvement is more cost-effective than their extraction and replacement with an implant supported fixed partial denture (Schwendicke, Graetz, Stolpe, & Dorfer, 2014). A study assessing the actual cost of retention of molars in the same health system showed that cost for retaining periodontally compromised molars were mini - mal (Schwendicke, Plaumann, Stolpe, Dorfer, & Graetz, 2016). Patient preferences There is a strong patient preference for tooth retention (IQWiG, 2016). Applicability The guideline can be applied since it is independent of availability of materials and a segment of the dental workforce has been trained or can be trained to deliver surgical furcation treatment in the different European health systems. R3.11 | What is the adequate management of residual deep pockets associated with mandibular Class II furcation involvement? Evidence-based recommendation (3.11) We recommend treating mandibular molars with residual pockets associated with Class II furcation involvement with periodontal regenerative surgery. Supporting literature Jepsen et al. (2019) Quality of evidence 17 RCTs ≥12 months (493 patients). Grade of recommendation Grade A—↑↑ Strength of consensus Consensus (7.6% of the group abstained due to potential CoI)
Background
Intervention See previous sections. An algorithm for clinical decision-making in the treatment by periodontal surgery of molars with furcation involvement (Class I, Class II) and residual pockets is depicted in Figure 2. Available evidence The evidence base includes 20 RTCs with 575 patients (Class II buccal/lingual mandibular and maxillary buccal furcation involve - ment) and seven observational studies with 665 patients (Class II interproximal and Class III). Previous systematic reviews have addressed the clinical performance of periodontal therapy of teeth with furcation involvement (Huynh-Ba et al., 2009; Nibali et al., 2016). Risk of bias High quality of evidence of RCTs . Low quality of evidence for obser - vational studies.
Background
Intervention See previous sections.
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